I was a kid when our family went to Iran. … I left school and started working in a publishing factory. There were people who used opium in that factory. I wanted to do my job properly and not get tired easily, so I also started using opium. I really enjoyed it. It helped relieve my fatigue.
I was still using opium after I left the factory. I enjoyed it, but the pleasure was temporary. … I used drugs for almost 14 years. I started with opium and then moved on to other drugs, such as heroin and crystal meth. Crystal changed my appearance. My teeth rotted. … When I came back to Afghanistan, I could only find opium and heroin easily. I didn’t use crystal after I returned from Iran.
Every person with a drug problem has their own story of how it all began. This man, 45-year-old Reza from Balkh, is a former drug user of 14 years who like many Afghans started using opium when he was living in Iran. Opium, contrary to the movie-created myths about its effects, is often used in Iran and Afghanistan by manual labourers to get some relief from the pain of sore muscles and to suppress their appetite because it slows down the digestive system. Other explanations given by our interviewees of why they started using drugs included how it helped ease physical pain, numb trauma or because others were using them.
Afghanistan has a massive problem with drug use. The last Afghanistan National Drug Use Survey, commissioned by the Colombo Plan in 2015, estimated that the country could have had between 2.9 and 3.6 million drug users, which would translate into about a tenth of the population using drugs. 31 per cent of the households whose members were tested were found to have at least one person who was using drugs. The rate of drug use was estimated to be higher in men than women (16 per cent of those tested, compared to 9.5 per cent, with children testing at a comparable rate to women) and three times higher in rural than urban areas (13 per cent compared to 5 per cent), with rural households also testing higher (39 per cent compared to 11 per cent).
The most prevalent drugs, the survey found, were opioids (including heroin, opium and prescription drugs like codeine) – 19 per cent of those tested, followed by cannabis – 11 per cent and two classes of pharmaceutical drugs that are generally prescribed for anxiety and insomnia – benzodiazepines, such as Valium – 5.1 per cent and barbiturates, such as phenobarbital – 1.1 per cent. Since then, methamphetamine, often referred to as crystal meth or in Afghanistan shisha, has emerged as a new drug with widespread use (see AAN reporting from 2015 here), alongside what Afghans refer to as ‘tablet K’, a cocktail of methamphetamine, opium and MDMA/Ecstasy.
Since returning to power, the Islamic Emirate of Afghanistan (IEA) has moved to address various narcotics-related issues. In April 2022, Supreme Leader Mullah Hibatullah Akhundzada banned the cultivation of opium and the production of opiates and other drugs and on 25 January 2023 issued a new order with a policy aimed at drug users:
Because using drugs can slowly affect a person’s life, the Islamic system has a duty to prevent its people from using every kind of drug. Governors of all provinces should take necessary action to prevent people in their province from using drugs. Centres and treatment facilities should be established for those already addicted, which must urgently fulfil whatever is necessary for their treatment.
Following the third UN-convened meeting of special envoys on Afghanistan, held from 30 June to 1 July in Doha (see this AAN dossier on previous meetings), the office of the acting Deputy Prime Minister for Political Affairs Mawlawi Abdul Kabir announced the formation of a high commission dedicated to combating intoxicants and narcotics. The purpose of establishing the commission, he said, was to combat intoxicants and narcotics, find alternative crops for farmers and set up treatment for drug users, Afghanistan International reported.
A new drug user survey is underway that will provide more detail about the current usage of drugs in Afghanistan. However, the scale of the problem is not in question, nor is the certainty that there is a need to act and as the 2015 Afghanistan National Drug Use Survey concluded:
Drug use is a treatable chronic illness that can be controlled with appropriate treatment and follow-up programs. Funding for treatment, aftercare, and frequent testing is a long-term investment in Afghanistan that will have very positive social and economic outcomes.
Yet, moving from recognising the need for action to taking action is not so easy, both in terms of available resources and the methods used.
The availability of drug treatment centres
The first thing to stress is that the number of treatment facilities for drug users, particularly centres outside the public sector, has fallen drastically since the collapse of the Islamic Republic of Afghanistan in August 2021, as donor money dried up. That being said, how many drug treatment centres were actually operational before August 2021 is unclear, although there are a few pointers. The United States Department of State’s Bureau of International Narcotics and Law Enforcement Affairs (INL) reported that by 2020, it had established a network of 103 drug treatment centres providing residential, outpatient and home-based treatment services in partnership with the Colombo Plan Drug Advisory Programme (CPDAP). Several dozen drug treatment centres of various types (residential and non-residential) were also established by organisations partnering with the United Nations Office on Drugs and Crime (UNODC), with others such as Médecins du Monde (MDM) also running some of their own. Over the years, a number of these centres were handed over to the Afghan government. The Ministry of Public Health (MoPH), for example, reported that it ran 50 treatment centres in 2019.
Even during the Republic, the infrastructure for treating drug users was considered insufficient, given the number of people using drugs. There was also concern about the lack of trained staff in government-run centres. This was documented in a 2019 Special Inspector General for Afghanistan Reconstruction(SIGAR) report on the US government-funded drug demand reduction programmes that found that projects implemented between 2013 and 2018 had helped only three to five per cent of Afghan drug users. Many centres that had been transferred to the Afghan government lost their trained staff because the MoPH did not keep its commitment to INL and had fired between 10 and 15 per cent of NGO staff working at the facilities. In some instances, SIGAR said, government officials had also forced trained staff to resign.
Afghan governments, both Republic and Emirate, have favoured large treatment centres that can admit thousands of patients, compared to donor-funded centres that cater for a maximum of 300. A case in point, as soon as the drug treatment decree was published in January 2023, was the opening of a 5,000-bed centre in Kabul (see a ToloNews report on the announcement here). Previously, the Ashraf Ghani government had opened a 1,000-bed centre on the grounds of the former military camp Phoenix in Kabul in late 2015 (see a ToloNews report from 2015 here).
Following the IEA takeover in August 2021, opportunities for treatment in smaller facilities shrank further. Many centres ceased to exist, especially those that had been supported by the US government, which froze its financial support to Kabul.
In May 2022, the Ministry of Public Health said that 44 out of 88 rehabilitation centres (not specified if all, or just government) were still active (see ToloNews report here). The most recent survey of the country’s existing drug treatment infrastructure, part of a national survey of drug use by UNDP and UNODC (see footnote 7) identified 113 centres, including three private hospitals, across 34 provinces. However, AAN was told by a source close to an ongoing survey that the data suggested that not all of them were still operational. In December 2023, The Lancet reported that only 10 per cent of treatment centres were still active:
According to email communication with Dr Abdul Qudos Saadat (Afghanistan Ministry of Public Health, personal communication) on Aug 16, 2023, following the Taliban takeover of the government and due to the reduction in international and public funds, only 10% of the drug treatment centres remained functional with international support, 44% were closed, and the remainder were running with a limited budget. Furthermore, as of Aug 15, 2023, the number of needle and syringe programmes had fallen to eight and the number of opioid substitution treatment sites had fallen to six.
A doctor from Kabul, who wished to remain anonymous, confirmed to AAN that most of the centres, especially outside the public sector, had indeed been closed:
In Kabul, most rehabilitation centres were in rented houses and after the political developments, the new government could not pay the rent, so they were shut down. For the moment, only the government-run centres are functioning and treating people with an addiction. Now, there are 59 treatment centres active all over the country. There are also huge camps in Kabul, Kandahar and Herat. The Deputy Ministry of Interior for Counter-Narcotics established these camps, but the Directorate of Narcotics of the Ministry of Public Health (MoPH) provides the services for them.
An MoPH official quoted in The Lancet article, Dr Saadat, was also quoted as saying the situation for drug users in the government camps was not good as there were no doctors and shortages of other professional staff, medicine and facilities (see also this report from Hasht-e Subh here).
AAN contacted several doctors working in the provinces to get a snapshot of the situation there. Dr Khalil Nurzai from Nimruz described the woeful under-resourcing of an 80-bed hospital for male drug users and a 20-bed hospital for women in his province:
There are no doctors in the 80-bed hospital. When there are no doctors, how can you provide treatment? How do you meet the patient’s health needs? It is even worse in the 20-bed hospital for women. There are no doctors or nurses. There is only a cook and a guard.
In Kandahar, the chief physician at the hospital for the treatment of male drug users, Dr Abdul Salaam Bashir, told AAN that there was no longer an active women’s treatment centre because the staff, including the doctors, had left the country after the fall of the Republic. However, he said that, since the re-establishment of the IEA, the capacity of the male treatment centre had increased from 70 to 100 beds.
The treatment is the same as under the previous government. Drug addicts have been rounded up, which is a good step, and I see that their number [on the streets] has decreased. There is not much relapse either because they don’t have easy access to drugs.
He added that, to his knowledge, the IEA does plan to reopen the women’s centre, although it is not clear when.
A female medical employee in a women’s drug treatment centre in Bamyan told AAN there was insufficient capacity to treat the many drug users in the province.
There are two drug treatment centres, a 20-bed centre for men and another for women. I believe this is not enough for the number of drug users in Bamiyan. Although the IEA occasionally rounds up drug users and brings them to the treatment centre, many can still be seen in more remote of the city.
The director of a private treatment centre in Balkh, Muhammad Asif Anwari, said that MoPH’s 100-bed hospital for drug users in Balkh was still operational, but many private centres in the province had closed.
Treatment for drug users
One of the key aspects of IEA drug treatment policy is the use of force. The Ministry of Interior, for example, was quotedin February 2023 saying that more than 80,000 drug users had been “collected from across the country after the Islamic Emirate swept into power.” Although it is not clear exactly what “collected” meant, reporting from those months, such as this VOA video from April 2022, featured footage of raids and round-ups of drug users (VOA reported from Paktia and Daikundi provinces). In February 2023, ToloNews reported that 17,000 drug users had been ‘collected’ in the past month, including 60 women, some of them found under the flyover in Pul-e Sukhta in Police District 6 in west Kabul (see AAN’s previous report for background on this location). Officials in neighbouring Police District 5 said they had found 60 corpses during those operations.
By December 2023, according to the chief of staff for the Deputy Minister for Counter-Narcotics, Hasibullah Ahmadi, nearly 100,000 drug users had been rounded up across Afghanistan and taken to rehabilitation centres since the Emirate regained power (see this ToloNews report). Once taken to a centre, drug users are subjected to zor darmani (referring to what, in English, is called ‘involuntary treatment’), ie drug users are detained like criminals and forced to stop taking drugs in what is colloquially known as ‘cold turkey’. It is a method, says the UNODC, that is seldom effective and goes against basic human rights and freedoms. It often involves cold baths, staying in prison-like conditions, no painkillers and restriction of movement, including binding patients to beds. The first Emirate took the same approach, as described in detail by David Macdonald in his book, ‘Drugs in Afghanistan: Opium, Outlaws and Scorpion Tales’. The Republic’s drug treatment regime was subject to more external scrutiny than the IEA, but in the large treatment centres during that era, patients were often also subject to ‘cold turkey’ roughness.
The private practitioner in Balkh, Dr Muhammad Asif Anwari, praised the Emirate for rounding up drug users, even though he did not think it a solution in itself:
I really admire the IEA for rounding up drug users from the streets and other places. It’s a positive step and a preventative measure. I believe this stops more people getting accustomed to drugs. This is something the previous government failed to do. In fact, in the last years of the Republic, drug users were everywhere, even in the space between two roads. It was really awful and had a bad effect on people, including schoolchildren, passing through those areas. Now, we don’t see drug users in public areas or under bridges. However, this doesn’t mean their number’s gone down or that many have been provided with treatment. I know people who use drugs in their homes and [other] places where the government can’t see them and in sarais [shopping malls or commercial premises]. At least in the northern provinces, such as Balkh, Baghlan, Samangan, Sar-e Pul and Jawzjan, I’m aware that there are drug users who are too afraid of the IEA to come to public places in the way they did before.
One lesson from the Republic, he said, was that private treatment centres are more successful than government ones because of their use of psycho-social counselling:
Authorities at that time [the Republic] were admitting that only three to five per cent of those treated [at government centres] did not ever relapse. However, about 20 per cent of those who received treatment in private clinics didn’t relapse. The treatment process in private centres was different. They only gave medicine to drug users for a few days, but then mostly talked to them to convince them to quit using drugs. Drug users received a lot of counselling and attended meetings with other drug users who had already quit.
Another doctor from a private clinic, Dr Farhad Shafaq in Ghazni city, also questioned what happened to drug users after they were rounded up. He said many had been taken away from under a bridge in the city and then to a camp:
They kept them there for treatment for five or six months. But when they were allowed to leave the camp, they relapsed. I believe it is because access to drugs is easy. They’re available everywhere. There are many [users] under the Pul-e Maida bridge [again]. Although opium cultivation has decreased, industrial drugs, such as methamphetamine, are available on the market.
To try and understand better the experiences of drug users, we spoke to a number of current and former users about their experiences. Some had received treatment in private or public centres recently or in the past. Those interviewees who had been successfully treated for drug addiction underlined the importance of small, community-based centres with a people-centred approach. Three of our interviewees said they had relapsed multiple times, including after going through rough and often inhuman treatment in government-run treatment centres.
In the words of drug users
One of the interviewees who struggled with relapses over the years, but was eventually successfully treated in 2017 is Reza from Balkh, whose words began this report. He ascribed his success partly to the support of family and friends, especially his wife and mother, but largely to the efforts of a small NGO, Aramesh:
I didn’t believe I could be treated. … My mother and wife persuaded me to go. They even cried and said, “Please, for God’s sake, go and see yourself. Many people have received treatment and you might too. Think about yourself and about us. You can’t live this way anymore and you have brought us trouble.” I couldn’t bear to see my mother and wife crying. They hadn’t done before. I think they had really lost their patience. So, I went to the private treatment centre, Aramesh. When I went there, I found it was really different from the treatment centres in Iran.
They had the same method as the centre for motadan-e gomnam [Narcotics Anonymous]. They held many meetings with drug users and gave them books to read – if they could [read]. Many drug users who’ve been successful in quitting [still] attend these meetings. I myself attended many meetings. They got me to understand that I was sick. They got me to believe that I was the only person who could decide and that I could help myself and my family and quit using drugs. … I’ve been clean for around seven years now.
35-year-old Muhammad who lives in Sar-e Pul province was also helped by Aramesh, in 2017 and has not used drugs since. He was born in Iran, but after he returned to Afghanistan in 2004, he started using opium.
I got a job as a teacher. I worked there for two years and became friends with a few people who were using opium. I thought I could use it too, so I began using it and enjoyed it. I was not using much at the beginning – once in two or three months. Then, I fell in love with a girl in the area. I sent my family to her home to ask her parents to let me marry their daughter. They agreed. I was happy. I got married, but my wife and the rest of the family didn’t know I was using opium.
Soon, he said, he began using opium more regularly. He got fired after the school principal discovered he was a drug user. He found another job at an office but left it after six months. In 2016, his family found out about his drug use and sent him to a government-run centre, but he relapsed. He eventually found Aramesh through a friend who had used to take drugs:
He gave my brother the centre’s card and told him to take me there. He told my brother it was the only centre that could help me. I went there with my wife and stayed for 72 days. My life, my mind and my thoughts changed while I was there. They helped me understand I was sick and that I could get better if I could muster the will to quit. I attended many meetings. I’ve been clean for around seven and a half years now. I have a job and I have my family. I kept my wife from leaving me and I have a happy life.
Another positive account, again via a Narcotics Anonymous programme, was given by 38-year-old Khalid from Mazar-e Sharif. He had been a user of various drugs for 12 years, he said, but had now been clean for five years and six months.
When I was very young, I was looking for fleeting pleasures and that is why I started using opium. Gradually, I began to use heroin and then crystal meth. I used drugs for 12 years. I lost everything. I lost my job. I tried several times to quit, but every time I could remain clean for a week or two and then I began using drugs again. Finally, I got to know about Narcotics Anonymous, where I went for detoxification and attended several meetings helping people withdraw from drugs. I’m still in touch with them and still attend meetings, after finding out that they hold them outside the centre as well. I began to read books with other attendees. They helped me overcome my addiction.
Karim, a high school graduate living in Kabul, said he had used drugs for seven years. He used to spend most of his time in Shahr-e Naw Park but described how lucky he was that his family had allowed him to come home at night. He managed to stop using drugs, he said, after a good friend encouraged him to seek help in a treatment centre:
I went to the treatment centre in Jangalak [a neighbourhood in east Kabul] in 2022 and I was there for 45 days. My friend was working there. Quitting drugs is really difficult, but if you’re determined, you can do it. I thank God, and then my friend, who helped me stop using drugs. I have been clean for a year and a few months. …
The situation in Janglak treatment centre is not that proper. I mean it’s not as good as it should be. They don’t provide services for drug users. When I had the desire to use drugs [waqt-e ke khumar meshodam], they got me to take a cold bath. Sometimes, they gave me pills to get rid of the pain. I am happy now to have received treatment and recovered.
Dost Muhammed from Mazar-e Sharif was a drug user for 15 years. He relapsed several times and lost his reputation and wealth during those years. Seven months ago, the IEA counter-narcotics department came to his shop:
They took me to a camp by force. I was in the camp for three months. The situation in the camp was terrible because there were many drug users in one hall. There were beatings and cold-water baths. They didn’t give us enough food and there was no medicine.
He said he thought to himself that in order to get out of his situation and regain his family’s trust, he had to quit using drugs. He was helped, he said, after leaving the camp by Narcotics Anonymous. “Fortunately, I managed to succeed,” he said. “I’m clean. I have my shop and can work. My family and the society trust me.”
Another drug user from Kabul, Sharif Wahidi, told AAN about how both he and his brother had been using cannabis for several decades, but scarcity of cannabis under the Emirate, which had driven the price up, had made it unaffordable and they had stopped or substantially reduced their use of it.
I’ve been using cannabis for more than 20 years. … I used to smoke cannabis three or four times a day as it was cheap and easily available. Now, the Emirate is really serious in dealing with drug users. Cannabis is still available, but it’s too expensive. A small amount of cannabis costs 3,500 afghanis [USD 49], so I can’t smoke often. I can use it only once every night, but a very small amount. I’m trying to quit it forever and hope I can make it.
Sharif said his brother had quit smoking cannabis after 40 years of using it.
He has become very depressed and prefers to be alone. He stays far from his family in his small garden. I think the reason my brother got depressed is the fact that he quit using drugs all at once. He should have stopped gradually. I don’t want to face the same problem, so I will stop slowly.
One of our interviewees was still struggling with drugs. 28-year-old Turab Jaffari said he had been taking drugs for more than 10 years. The police took him by force to a treatment centre in April 2022, but once he got out, he said, he relapsed:
I was under a bridge in Ghazni city when the Taleban police arrested me and forced me to go to a camp. I didn’t want to stop using drugs. I was there for two months. There were a lot of problems: too many drug users and no doctor. They provided us with little food and forced us to take cold showers. I didn’t have access to drugs there. After two months, they let me leave. Once I got out, I returned to the same area, under the bridge and resumed using drugs. I have nowhere to go. My parents and sisters are in Iran. A brother of mine is living here in Ghazni, but he doesn’t allow me to stay in his home.
He says that he cannot quit without help from family and friends:
I have no job and no one to support me, so I can’t quit drugs. I have been using drugs for more than ten years. Now I go to different places so the Taleban won’t arrest me again. I go under the bridge with some other users, and when one of us notices the Taleban coming, we escape and go to another area.
Sharif, the cannabis smoker in Kabul, also reported that there, much of the problem had gone out of the public sight. He used to see drug users in his neighbourhood, he said, but the government had rounded them up and there were no longer many on the street. However, he said, it cannot control what people do at home.
There are many others who use drugs in their homes where the government doesn’t have control. Many young boys aged 15 to 16 use cannabis and cheap tablets such as zeegap or pregabalin [a medical drug used to treat anxiety, epilepsy, nerve pain and help support opioid withdrawal]. There are others who use tablet K, but it’s also expensive, so young boys can’t afford it. They buy pregabalin instead.
To sum it up
There are many reasons why drug use has become such a major problem in Afghanistan: traditional use of opium as pain relief medication; increasing contact with opiates (eg as cultivation, processing and trafficking all grew in volume); lack of public awareness of the harms done by drugs; and the need to treat trauma and mental health problems caused by forty years of wars and uncertainty.
War, over the 40 years, proved fertile ground for an illicit opium industry to flourish. During the Republic, the insurgency and counterinsurgency led to instability and corruption facilitated the expansion of drug cultivation and trade. The large-scale poppy fields no may longer exist, but stocks of opium paste are not yet run down. Even if opium and its derivatives become less easily available, as is evident from our interviews, drug users will switch, if their preferred drug is not available and demand from the enormous number of existing drug users will also continue to drive supplies. This is a big market and a business opportunity that some will not miss.
Given the diminished production of opiates in Afghanistan, we might witness an increase in synthetic drugs, like meth and tablet K. When it comes to meth, the IEA has made noticeable efforts to curb large-scale meth production (see this 2023 Alcis analysis), but small-scale meth production facilities are not so easy to detect. We might also see an increase in the use of prescription drugs, such as Valium, barbiturates and phenobarbital, as long as the sale of drugs over the counter remains unregulated and control is lax.
As to trying to reduce demand for drugs, neither the Emirate nor the Republic have had much success in dealing with Afghanistan’s massive drug use problem, as is evident from our report. Both administrations have favoured large treatment centres at the expense of the network of NGO-led and donor-supported community treatment centres, which have been largely unsupported and unappreciated by the government. Despite a multitude of evidence from the last 20 years that small treatment centres and the support of family and friends are crucial for users successfully coming off drugs, it seems that all Afghan governments think that the mass treatment facilities are a ‘silver bullet’ for the problem. All our interviews show that dedicated, gentle and personalised care has long-term positive effects, while rough and depersonalised treatment tends to lead to relapse.
Edited by Roxanna Shapour and Kate Clark
Afghanistan Peace Campaign
